New Roaring Fork Valley program helps with postpartum depression

Caitlin McKimmy, center, a research assistant at the CREST Lab, University of Colorado Boulder, answers questions during the Q & A session for the Alma Project held last week.Chelsea Self / Post Independent

Valley Settlement Project, a program that empowers immigrant families in the valley, has partnered with researchers at CU Boulder to spearhead a new program that helps women experiencing postpartum depression.

Researchers, clinicians, and mothers who have experienced depression following childbirth will help others living through the symptoms now.

The new program, also a study, is not only restricted to immigrant families, however.

The idea of using “peers,” or people who have lived through a similar experience, has become more popular in addressing mental health concerns, across the globe, and the Alma Project uses the same approach.

Mental health advocates say non-specialists or lay people have helped increase access to mental health care for a myriad of reasons.

“The heart of the Alma program is the team of trained mentors, mothers who have faced depression in their own lives and want to support others who are struggling with depression symptoms during pregnancy or early parenting,” the organization wrote in an information sheet.

The project is called “Alma,” because its leaders hope women will resonate with the multiple meanings of the word. In English, it means “nourishing” and “kind” and in Spanish it means “soul.”

“Resonance fuels a lot of the power in this,” said Sona Dimidjian, a psychology and neuroscience professor at CU Boulder, who is also the lead investigator of the Alma Project.

“Peers aren’t only sharing knowledge and support, they’re also countering the stigma a lot of people feel in respect to depression and other mental health concerns because they’re saying, I’ve struggled and I’ve found this has helped me, and I want to open a conversation about this.”

Access to care depends on geography, race, ethnicity, income, and other factors, but it’s a major problem, she added.

There’s no single factor that causes depression but research says there are likely many causes and experiences under the “depression umbrella” that will affect the lives of some people more than others, she said.

Studies describe depression as interfering with people’s ability to engage in their lives in the way they most want.

That’s also true of pregnancy and caring for a new baby, Dimidjian said.

“Taking care of a new baby is really hard work, even when you’re not depressed, and we live in a time and culture where there’s not a lot of support for women and transition into parenting in general,” she said.

“When you add the weight of depression, in the midst of what is already a very demanding time period, that weight of depression can make it hard for a mom to parent in the ways she wants,” she added.

Kenia Pinela, a peer, or compañera (in Spanish) says there are additional obstacles for immigrant mothers with postpartum depression.

“Being in a country that you have no idea how to maneuver, not knowing the language at the baby’s appointment, you can’t advocate for them, you can’t ask important questions,” she said.

Sometimes information and sentiment gets lost in translation and finding and utilizing an interpreter can be a challenge for many families. Cost can also be a barrier when looking for help, she added.

“There’s this pattern of isolation from migrating here and it doesn’t matter if you’ve been here for eight years or five years,” she said.

“Not knowing the language and feeling like you [don’t] belong makes you more likely to have postpartum depression. There’s just not a sense of security. There’s tons of isolation. The language barrier doesn’t let them get exposed to community events. Having family miles away and not talking to them for a month is difficult,” she said.

Typically, postpartum depression means “a 360 turn around” for a new mother, Pinela added. A feeling there’s a lack of support from a husband or partner can sometimes cause a new mother to feel depressed.

Leaving a job and transitioning to a stay-at-home mom role can also affect some women, causing them to feel of lesser value, Pinela says.

It’s Valley Settlement’s first stab at offering a mental health service, Pinela said. The organization realized a need for the program after it saw rampant depression and limited bilingual therapists.

“When you feel good and confident and you know what you want in life, you can handle a problem,” she said. But when one feels isolated or down, any little problem can feel like the world is crashing down, she added.

BEHAVIORAL ACTIVATION

Peers meet mothers in the program a total of six to eight times. This is the first group the project is seeing and the first group of mothers is scheduled to finish the program by Sunday.

Peers follow a model called Behavioral Activation, or BA, a type of psychotherapy many studies have deemed effective in helping with depression, Dimidjian says.

A participant coming into the program must take a test, which will determine if she’s appropriate for the project. A scoring system is used to determine whether or not she can utilize the program. If she needs other outside services, the project helps her find them. Using outside services in conjunction with the Alma Project’s study is also an option, Dimidjian said.

The Behavioral Activation model focuses on the steps someone can take to come out of depression, rather than the causes.

The program focuses on the fact that BA can be used anywhere at any time by any person.

Anahi Collado, a clinical psychologist, teaches peers in the program how to use BA effectively. She compares it to scheduling activities in life that are “non depressogenic,” meaning healthy and consistent with one’s values.

“It’s this idea that you do things in order to feel better despite depression. It’s empowering yourself to do things that are going to better your mood,” she said.

She says the concept shows women that depression comes from the environment rather than a person’s biology. It helps stigmatized populations view their depression in a way that shows they have the power and the tools to improve their wellbeing, she said.

The BA model can help women avoid falling back into a depressed state, she said. This individualized platform helps “the individual in front of you, without making assumptions or stereotyping people.”

There are programs out there specifically “for the Latino population,” that categorizes participants in specific ways. This project is not that, she said.

WHY NOW

Dimidjian says she came up with the idea for the project after a culmination of events, after 15 years of studying how to best treat depression in pregnancy and early parenting.

She noticed the resounding strength and wisdom women had during their pregnancy, as well as their sense of commitment to parenting regardless of their struggles.

She saw a desire from women who have been helped by other programs she has led that wanted to pay it forward and give back to those who were also in a similar need. Thus, the idea for the Alma Project was born.

“We think of these as basic life skills that are relevant in terms of caring for ones mood and we think its possible that there’s something especially important about having the support from someone else who has walked in your shoes,” she said.

She said it wasn’t practical to have therapists and psychologists work with mothers, because of the limited availability of bilingual, bicultural providers in this region and the U.S. as a whole.

The program isn’t a replacement for psychotherapy or medicine or treatment, it’s meant to be a broader system of care, she said.

Pinela is seeing a shift in awareness around depression and other advocates would say there’s more conversation around mental health as a whole.

She says breaking the stigma is necessary to save women from being shunned for experiencing a mental illness they can’t control.

“It’s common and it happens, and there’s something you can do about it, so why not,” she asked.

“Our culture tends to put women down for even saying they have depression, and that’s not OK. We need to have awareness so more people can access those resources,” she said.

REVERBERATIONS

It’s too early to scrape data, Dimidjian says. But, anecdotally, she hears women are making progress.

This is the first group of mothers participating in the study, and Pinela says she has already seen transformation in less than eight weeks.

“You begin to see more happiness, more smiles, more understanding, awareness of what’s happening to them. It’s almost like you begin to hear and see that things are kind of going similarly to how they were before this event had occurred,” she said of the women’s pregnancies.

“You begin to see them to start working toward what they want their life to be.”

A sense of pride emerges, human connections become more important, and women start seeking more activities, Pinela said.

She sees the women tackling obstacles in a more controlled and confident way, and that’s one of the most satisfying parts of the process, she says.

FUTURE PLANS

The study is also running in urban areas, including two other locations in Denver. The Valley Settlement study is geared toward Spanish-speaking mothers in rural areas, and the Denver-based programs are geared toward helping English-speaking women in an urban area.

Dimidjian plans to use these preliminary studies to replicate the program in new settings across the state and nation.

She’s currently working with other agencies and programs within the state to integrate Alma peer mentoring into community mental health services, family partnering, perinatal services, and more.

These kinds of partnerships could especially help mothers who need more than the six to eight meetings the Alma Project currently offers. She expects the study to continue for a number of years.

“I think that there’s an opportunity to connect to that hope and optimism that a lot of parents feel during pregnancy and early parenting that even when they’re struggling, overwhelmed, depressed, uncertain about what to do, there’s kind of a seed of possibility,” Dimidjian said.

“I think if you nurture that, it makes this a really powerful window of opportunity.”

Working with women during pregnancy and early parenting has the potential to not only influence the mother but also future generations, she said.

Working with women to implement healthy living into their own lifestyles at a time when they’re raising a child allows them the opportunity to change their interactions with their babies, she said.

In turn, they’re passing that knowledge on to their kids, who can continue the cycle of expanding that knowledge, she said.

“The more people that are doing it, that’s the way we change the world, one conversation at a time,” she said.

Added Pinela, “I think the biggest thing is for the community to know there’s support and there’s help out there and that they’re not alone.”

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